Endometriyozis varlığının ve endometriyozis kist eksizyonunun over rezerv belirteçleri üzerine etkisi
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Date
2011
Authors
Kasapoğlu, Işıl
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Endometriyozis ve infertilite arasındaki ilişki iyi bilinmesine rağmen mekanizma halen tartışmalıdır. Erken evre endometriyozisli hastalarda bile azalmış fertilite, endometriyozisin over rezervi üzerine olumsuz etkisini gündeme getirmiştir. Diğer önemli bir soru; fertilitenin arttırılması amacı ile gerçekleştirilen endometriyoma kist eksizyonunun over rezervine etkisinin ne yönde olduğudur.Çalışmamızda; endometriyomalı hastalarda, endometriyoma varlığının ve laparoskopik kist eksizyonunun over rezervini nasıl etkilendiğini tespit etmeyi amaçladık.Endometriyoma nedeniyle laparoskopik cerrahi geçiren 30 hasta ve benzer yaş dağılımına sahip 30 sağlıklı kadın kontrol grubu olarak çalışmaya dahil edildi. Her iki gruptaki 30'ar kadına menstrüel siklusun erken folliküler fazında follikül stimüle edici hormon, östradiol ve Anti Müllerian Hormon (AMH) ölçümü yapıldı. Ultrasonografi ile her iki overdeki toplam antral folikül sayısı (AFC), over volümleri ve endometriyoma boyutları hesaplandı. Kist eksizyonu uygulanan hastalar postoperatif 6. hafta ve 6. ay sonrasında kontrollere çağırılarak over rezerv belirteçleri tekrar değerlendirildi. Alınan doku örnekleri histopatolojik inceleme için Patoloji Bölümü'ne gönderildi. Çıkarılan kist duvarında over dokusu bulunup bulunmadığı, spesmende primordial folliküller sayılarak değerlendirildi.Kontrol grubu ile hasta grubunun preoperatif değerleri karşılaştırıldığında, AMH ve AFC değerleri anlamlı olarak endometriyoma grubunda düşük bulunmuştur (p<0.001). Postoperatif 6. hafta over rezerv belirteçlerinde preoperatif değerlere göre anlamlı fark izlenmemiştir. Postoperatif 6. ay sonrasında, bilateral ve > 5 cm endometriyoması olan hastalarda AMH değerleri anlamlı olarak azalmış bulundu (p=0.021- p=0.039).Sonuçta endometriyoma varlığının over rezervini azalttığı ve kist eksizyonun erken dönemde değil ancak 6. aydan sonra uzun dönemde bilateral ve > 5 cm endometriyoma eksizyonu yapılan hastalarda over rezervini olumsuz etkiliyor olabileceğini düşünmekteyiz.
Association between endometriosis and infertility is well known but the mechanism is still a controversial issue. The patients with minimal endometriosis have subfertility, adressing about the effects of endometriosis on ovarian reserve. Another important question is; if the surgery itself impairs the ovarian reserve.The aim of our study is to find out that if the endometriosis itself or the surgery effects the ovarian reserve.30 patient who had undergone laparoscopic operation for endometrioma were the study group and 30 healthy women with similar age distrubition were enrolled as control group. Preoperatively on early follicular phase of menstruation FSH, estradiol and AMH of patients were measured. Also antral follicle count in both ovaries, dimensions of endometrioma and ovarian volumes were assessed with ultrasonography. All evaluations were performed for the control group also. Postoperatively the patients were evaluated for ovarian reserve on the 6th week and after 6 mounth of operation. The speciemens were evaluated for the presence or absence of the ovarian tissue adjacent to the cyst wall by counting the primordial follicules.When the control group and study group compared for ovarian reserve; AMH and antral follicle count values were found significantly decreased in the study group (p<0.001). The second postoperative evaluation showed that patients with bilateral or > 5 cm endometriomas had significantly decreased AMH levels (p=0.021-p=0.039).As a result; presence of endometrioma is associated with decreased ovarian reserve and cycst excision for bilateral or > 5cm endometriomas canbe associated with decreased ovarian reserve.
Association between endometriosis and infertility is well known but the mechanism is still a controversial issue. The patients with minimal endometriosis have subfertility, adressing about the effects of endometriosis on ovarian reserve. Another important question is; if the surgery itself impairs the ovarian reserve.The aim of our study is to find out that if the endometriosis itself or the surgery effects the ovarian reserve.30 patient who had undergone laparoscopic operation for endometrioma were the study group and 30 healthy women with similar age distrubition were enrolled as control group. Preoperatively on early follicular phase of menstruation FSH, estradiol and AMH of patients were measured. Also antral follicle count in both ovaries, dimensions of endometrioma and ovarian volumes were assessed with ultrasonography. All evaluations were performed for the control group also. Postoperatively the patients were evaluated for ovarian reserve on the 6th week and after 6 mounth of operation. The speciemens were evaluated for the presence or absence of the ovarian tissue adjacent to the cyst wall by counting the primordial follicules.When the control group and study group compared for ovarian reserve; AMH and antral follicle count values were found significantly decreased in the study group (p<0.001). The second postoperative evaluation showed that patients with bilateral or > 5 cm endometriomas had significantly decreased AMH levels (p=0.021-p=0.039).As a result; presence of endometrioma is associated with decreased ovarian reserve and cycst excision for bilateral or > 5cm endometriomas canbe associated with decreased ovarian reserve.
Description
Keywords
Antimüllerian hormon, Endometriyoma, Over rezervi, Laparoskopik kistektomi, Antimullerian hormone, Endometrioma, Ovarian reserve, Laparoscopic cystectomy
Citation
Kasapoğlu, I. (2011). Endometriyozis varlığının ve endometriyozis kist eksizyonunun over rezerv belirteçleri üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.